Provider Demographics
NPI:1295926855
Name:WESTCHASE OPHTHALMOLOGY INC
Entity type:Organization
Organization Name:WESTCHASE OPHTHALMOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-792-0444
Mailing Address - Street 1:11603 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4306
Mailing Address - Country:US
Mailing Address - Phone:813-792-0444
Mailing Address - Fax:813-792-0066
Practice Address - Street 1:11603 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4306
Practice Address - Country:US
Practice Address - Phone:813-792-0444
Practice Address - Fax:813-792-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5085Medicare PIN
FLG12925Medicare UPIN